Motor vehicle crashes are the leading cause of death for American Indian (Al) children, proper use of age-appropriate child restraint systems can substantially reduce the number of fatal injuries, however, many Al children still ride completely unrestrained or improperly restrained when traveling. In a recent vehicle observation study in 6 Northwestern US tribes, the majority of Al children age 8 or under rode un- (41%) or improperly (30%) restrained. While adult drivers in these tribes were commonly unaware of laws regarding vehicle restraints for children, they were receptive to receiving more information and training on proper use of child safety seats. One of the Healthy People 2010 injury prevention goals promotes the widespread and consistent use of child safety seats. Tribes in the Northwest have prioritized injury prevention, in particular, reducing morbidity and mortality from motor vehicles crashes among their membership. It is in response to a resolution passed by the member tribes of the Northwest Portland Area Indian Health Board that this application was prepared and submitted. Using a community based participatory research model, our team of partners from Northwest tribes, Northwest Portland Area Indian Health Board and Harborview Injury Prevention Center at University of Washington, propose to plan, implement, and evaluate child safety interventions in 6 Northwestern tribal communities. We plan to conduct qualitative interviews and focus groups to determine barriers to appropriate restraint use, work with tribes to design and carry out culturally appropriate interventions, and conduct observational vehicle surveys at three time points over the five years. We propose to use a staggered intervention design, implementing interventions in three tribes at a time, and comparing child passenger restraint use in all six tribes before and after each intervention. Tribes will be involved in every facet of the research process, including interpretation and future planning based on results. We anticipate that well designed, tribe-implemented programs will eliminate barriers, increase knowledge, and result in a sustained increase in child safety seat use.